Poststroke/CVA Hemiparesis
Conditions
Keywords
Stroke rehabilitation, Constraint-Induced Movement Therapy, Task-Oriented Training, grip strength
Brief summary
This controlled clinical study investigates and compares the effectiveness of CIMT and TOT in improving hand function among post-stroke patients. A total of 48 participants from hospitals in Sialkot will be randomly divided into two groups and receive a 3-week intervention consisting of 15 sessions. Outcomes will be assessed using the 9-Hole Peg Test, Jebsen-Taylor Hand Function Test, and grip strength, and the data will be analyzed using SPSS-21 under a single-blinded design.
Detailed description
This randomized clinical trial will compare the effects of Constraint-Induced Movement Therapy (CIMT) and Task-Oriented Training (TOT) on hand function in post-stroke patients. The study will be conducted over 11 months at Allama Iqbal Memorial Teaching Hospital and Life Care Hospital, Sialkot, with 48 participants (24 per group) recruited through convenience sampling and randomly assigned to either intervention. Eligible participants will be stroke patients aged 45-65 years in the subacute to chronic phase (\>3 months), medically stable, cognitively intact, and with minimal voluntary hand movement, while those with severe neurological, cognitive, or musculoskeletal impairments will be excluded. Group A will receive CIMT involving restriction of the unaffected limb and intensive task-specific training, while Group B will receive TOT based on functional, task-oriented activities with progressive difficulty. Both interventions will be delivered over 3 weeks (15 sessions). Outcomes will be measured using the 9-Hole Peg Test, Jebsen-Taylor Hand Function Test, and grip strength assessment. A single-blinded design will be used with blinded outcome assessors, and data will be analyzed using SPSS-21 to compare the effectiveness of both interventions.
Interventions
BEHAVIORALConstraint-Induced Movement Therapy
Participants will undergo intensive upper limb rehabilitation involving shaping techniques, repetitive task practice, and restraint of the unaffected upper limb for 90% of waking hours, 5 days per week for 3 weeks. The therapy is delivered for 3 weeks (15 sessions; 5 sessions per week), with each session lasting approximately 60 minutes of structured rehabilitation training plus additional functional practice as prescribed. Activities are progressively graded and include fine motor tasks, object manipulation, and functional reaching and grasping exercises designed to promote neuroplasticity and motor recovery
BEHAVIORALTask-Oriented Training
Participants will receive task-specific upper limb rehabilitation involving functional activities, bilateral tasks, object manipulation, and daily living task practice for 45-60 minutes per session, 5 days per week for 3 weeks. Each session consists of a 45-60 minute structured rehabilitation program including warm-up (ROM and stretching), task-specific training (reaching, grasping, pegboard, coin and card tasks), and bilateral functional activities with progressive difficulty and a cool-down phase. The intervention is delivered at an intensity of 5 sessions per week for 3 weeks, totaling 15 sessions.
Sponsors
Riphah International University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Outcomes Assessor)
Masking description
The outcome assessor was blinded to group allocation to minimize assessment bias during evaluation of hand function outcomes. Participants and therapists were aware of the intervention being administered due to the nature of physiotherapy rehabilitation treatment.
Intervention model description
Item Description Study Type Interventional Study Design Randomized Controlled Trial Intervention Model Parallel Assignment Primary Purpose Treatment/Rehabilitation Phase N/A (Behavioral/Physiotherapy Intervention)
Eligibility
Sex/Gender
ALL
Age
45 Years to 65 Years
Healthy volunteers
No
Inclusion criteria
Participants will be included if they meet the following criteria: * Age between 45 and 65 years * Both male and female participants * First-ever unilateral ischemic or hemorrhagic stroke confirmed by imaging * Stroke onset in subacute to chronic phase (\>3 months post-stroke) * Medically stable and able to sit independently * Voluntary wrist extension of at least 10 degrees and finger extension of at least 10 degrees in the affected hand * Mini-Mental State Examination (MMSE) score \> 26 * No significant pain or spasticity in affected upper limb (Modified Ashworth Scale \< 2) * Adequate sitting balance and trunk control for upper limb activities * Willingness and availability to complete the full intervention (3 weeks) * No significant musculoskeletal impairments (e.g., fractures or arthritis) affecting the upper limb
Exclusion criteria
Participants will be excluded if they have: * Severe spasticity (Modified Ashworth Scale \> 3) or joint contractures * Severe aphasia, neglect, or cognitive impairments affecting task performance * Recurrent or bilateral stroke * Severe upper limb impairment * Joint contractures or orthopedic limitations in the upper limb * Active infections, skin lesions, or wounds on the upper limb * Severe pain during limb movement * Participation in other upper limb rehabilitation programs concurrently
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Jebsen-Taylor Hand Function Test (JHFT) | baseline to 3 weeks | The Jebsen-Taylor Hand Function Test (JHFT) is a standardized assessment that takes approximately 15 to 45 minutes to administer and measures everyday fine and gross motor dexterity through seven timed tasks, such as writing, card turning, and object manipulation. Patients complete each task as quickly as possible with one hand at a time while the clinician records the completion time in seconds. Lower execution times indicate superior hand function, providing an efficient way to track pre- and post-treatment recovery or compare performance between limbs |
| Nine-Hole Peg Test (NHPT) | Baseline to 3 weeks | The Nine-Hole Peg Test (9HPT) is a standardized and reliable assessment used to evaluate fine motor dexterity and hand function in individuals with post-stroke impairments. The test requires the participant to place nine pegs into nine holes and then remove them as quickly as possible, with each hand assessed separately. Performance is measured by the time (in seconds) required to complete the task, with shorter completion times indicating better manual dexterity and hand function, while longer times reflect greater impairment. |
Countries
Pakistan
Contacts
PRINCIPAL_INVESTIGATORDr Shumaila Physio, MSNMPT
Riphah International University
Outcome results
None listed